Thrombolysis – The use of thrombolytic agents torestore coronary permeability significantly reduces mortalityin AMI 49,50. Reperfusion, when instituted early, limitsmyocardial damage, improves ventricular function andpromotes electrical stability. Late reperfusion may also bebeneficial, favoring ventricular scaring and remodeling.The thrombolytic agent and the way it is administeredseem to be important in reducing cases of cardiogenicshock. ISIS-3 study, which compared the administration ofthree agents (streptokinase, t-PA and APSAC), did notshow any difference among them in reducing cases ofcardiogenic shock 51. However, in the GUSTO study 52,where t-PA was administered using a faster infusion, agreater speed in coronary reperfusion rates was obtained,probably resulting in a smaller incidence of cardiogenicshock (5.1% x 6.6%, p<0.05). The development of newthrombolytic and adjuvant agents (platelet glycoproteinIIb/IIIa inhibitors) should favor these patients even more 53.However, for AMI patients in cardiogenic shock attheir initial evaluation, the benefit of thrombolytic agents isless obvious, with reports of smaller efficiency 49. Hypoperfusion,mainly of the coronary artery, is apparentlyresponsible for it. Concomitant use of vasopressor agentsand IABP increases coronary reperfusion rates 54. Contrarily,the study published by the Fibrinolytic Therapy TrialistCollaborative Group, compiling data from the most importantศึกษา randomized ควบคุม ด้วยยาหลอก thrombolysis ในอามิ แสดงให้เห็นว่าการลดความสำคัญในการตาย (เจ็ดชีวิตบันทึกสำหรับแต่ละพันถือว่า) ผู้ป่วย AMI ที่นำเสนอที่เข้าชม มีระบบ BP systolic < 100mmHgและอัตราการเต้นหัวใจ > 100bpm 55
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